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Paediatric respiratory failure (bronchiolitis) — DIPIMC MCQ

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HardPaediatric and Obstetric EmergenciesPaediatric respiratory failure (bronchiolitis)DIPIMCDipIMC

An infant with bronchiolitis initially had a respiratory rate of 70, which has now fallen to 25. The infant has become lethargic, the SpO2 is falling and the previously noisy breathing has become quiet, with intermittent grunting.

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Correct answer: C — Impending respiratory failure from exhaustion - support ventilation, give oxygen and transfer urgently

Explanation lettering: D = shown as B · B = shown as C · E = shown as D · C = shown as E

A falling respiratory rate with increasing lethargy and a quietening chest in a previously tachypnoeic, distressed infant indicates exhaustion and impending respiratory failure, not improvement, and requires ventilatory support, oxygen and urgent transfer. Interpreting the slowing rate as recovery (A) is a dangerous error. A tiring child whose effort and consciousness are declining is peri-arrest and must be escalated.

Reference: APLS; JRCALC Clinical Guidelines